In Texas, Uneven Expansion Of Obamacare Sows Frustration : Shots - Health News Despite the rollout of the Affordable Care Act, Texas still has 6 million uninsured people, low Medicaid reimbursement rates and narrow choices of doctors and hospitals for many who are insured.
NPR logo

In Texas, Uneven Expansion Of Obamacare Sows Frustration

  • Download
  • <iframe src="https://www.npr.org/player/embed/468255954/468607126" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
In Texas, Uneven Expansion Of Obamacare Sows Frustration

In Texas, Uneven Expansion Of Obamacare Sows Frustration

  • Download
  • <iframe src="https://www.npr.org/player/embed/468255954/468607126" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

AUDIE CORNISH, HOST:

Compared to adults nationwide, people in Texas are much more likely to say it's gotten harder to see a doctor over the past two years. That's one finding in a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. From KERA, Lauren Silverman takes a closer look at the barriers to health care in Texas.

VERA BROWN: My name is Vera Brown, and I'm trying to find a orthopedic surgeon that will take Superior.

LAUREN SILVERMAN, BYLINE: Vera Brown has been stuck aboard the doctor merry-go-round for years now.

UNIDENTIFIED MAN: Thanks for calling (unintelligible) health care.

SILVERMAN: She doesn't find the endless calls, questions or repetition amusing.

BROWN: When they say that I'm not covered, that means that I have to put off having surgery, and that begins to start messing with my health.

SILVERMAN: Brown, who's 45, has already had one hip replaced. Now the other is starting to feel numb. She used to be in physical therapy, but the clinic stopped accepting her insurance which is provided by Medicaid. She gets around her South Dallas apartment with the help of a walker. With an 11-year-old son still at home and a fixed income, traveling is hard.

BROWN: But if you have a little money and you can go to whatever doctor, that's fine, but what about the ones that does not have the income or the say-so or the know-how to go about doing this? We just lost out, and that's just not right.

SILVERMAN: Almost 1 in 5 people in Texas says it's gotten harder to see a doctor in the past two years according to the NPR poll. It didn't matter what kind of insurance they had. Dr. John Carlo says across the board, health insurance plans have narrowed their networks, shrinking the number of doctors and hospitals patients can see.

JOHN CARLO: The health plans are contracting with fewer and fewer health providers and hospitals, and they're using this as a cost-control measure. So it is very likely that somebody that in the past has had a lot more access to specialists - they're not finding that anymore, and they're having to travel greater distances to find those specialists.

SILVERMAN: About 70 percent of plans available on healthcare.gov in Texas are size small according to Dan Polsky of the University of Pennsylvania. Staying on top of which doctors are in or out of network is hard for administrators as well as patients. Carlo says his nonprofit health agency, AIDS Arms, has had to refer out patients who've been coming for years.

CARLO: Frankly, it's a mess. We just see this just so frequently where a patient comes in. You know, they're carrying a health-plan card. It looks good. They double check, and then when they go to file the claim to be reimbursed, they find out that they're not in the network.

SILVERMAN: And if you do find a doctor in network, there's the problem of actually scheduling the appointment. About a quarter of adults in Texas who do have a regular doctor say there's been at least one time in the past two year when they needed care but couldn't see their regular provider. Texas Health Institute researcher Dennis Andrulis says the Affordable Care Act has helped more than a million Texans get insurance, but the state has a severe physician shortage.

DENNIS ANDRULIS: What happens is the law is raising hopes for those who, in this state, have been chronically uninsured for such a long time. But then for those who are able to get insurance, they will find difficulty in accessing care.

SILVERMAN: Andrulis says for people on Medicaid, the situation is particularly frustrating. Texas chose not to expand Medicaid, and the rate it reimburses doctors for care is very low. The result - physicians in Texas have little incentive to take on new patients.

ANDRULIS: These are the seeds and the realities of frustration.

SILVERMAN: It doesn't surprise Andrulis that the majority of Texans who can't see a doctor in a timely manner go to the emergency room instead. As for Vera Brown, she uses a community health clinic where costs are low, supplemented by some medicine by her mother.

BROWN: She will give you a hug like no other. It will sooth your soul. And when you get through, it's like everything just gone away.

SILVERMAN: And for a minute, she can ignore the pins and needles in her hip and pick up the phone to make a few more calls to find a doctor. For NPR News, I'm Lauren Silverman in Dallas.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.